Mobilisation & Manipulation of the MTPJ's & IPJ's

MTPJ's

Instructions:

1. Flex the patient's knee to approximately 90°

2. Stabilise the patient's foot against your chest

3. With one hand, grab hold of the proximal phalanx with thumb and index finger. Curl the index finger so that it gives a better grip.

4. Then undertake the following series of movements for each MTPJ:

IPJ's

Repeat the above, but stabilise the proximal/intermediate phalanx with one hand, and the intermediate/distal phalanx respectively with the other.

Mobilisation of the 4th MTPJ

A closeup of the first picture: mobilisation of the 4th MTPJ

Distraction of the first MTPJ

 

1. MPJ's/IPJ's

Firmly grasp prox phalanx between index finger and thumb, with index finger bent and applied to the plantar aspect of the proximal phalanx

The other hand can either cup the heel (for long axis extension of the MPJ, or the thumb can be placed under the MPJ in question (just proximal to the joint), with other fingers stabilising over the dorsum

Gradually traction the joint in long axis extension, with plantar flexion as well in some cases

Be careful with the first MPJ

Joint dysfunction? add short fast thrust once end-range is reached
Can also be used for reduction of varus/valgus rotation of toes
Can add a Superior/inf glide at end DF/PF

(Figs 3.134/3.135 Michaud)

 

2: MPJ's & Tarsometatarsal joints

Usually sup-inf gliding motion available between all MT heads
Strong ligamentous support

Palpate region first - rule out Morton's neuroma - be careful
Can be performed with hands dorsal of plantar to foot

Test by grasping heads of adjacent MT's between the thumbs & index fingers and alternately shearing up and down, work distally to proximally

(Fig 3.137 Michaud)